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Generally, migraine begins as a dull ache and then develops into a constant throbbing and pulsating pain that you may feel at the temples, as well as the front or back of one or both sides of the head. The pain is usually accompanied by a combination of nausea, vomiting, and sensitivity to light and noise. Some people (about 15% of those living with migraine disease) experience an aura before an attack. The cause of migraine is believed to be chemical reactions in the brain. Treatment for migraine may include over-the-counter or prescription medications, as well as self-help techniques such as relaxation training and biofeedback.
About 15-20% of people with migraine get an “aura,” which is a manifestation of neurological symptoms that occurs before a migraine headache. You may see wavy or jagged lines, dots, or flashing lights; or you might experience tunnel vision or blind spots in one or both eyes. The aura can include visual or auditory hallucinations and disruptions in smell (such as strange odors), taste, or touch. Other symptoms include numbness, a “pins and needles” sensation, or difficulty in recalling or speaking the correct word. These neurological events may last as long as sixty minutes and will fade as the headache begins.
Certain physical or environmental factors, such as foods, hormonal changes, weather, and stress, can lead to or “trigger” a migraine. However, it’s important to remember that triggers are different for everyone. That’s why, to help prevent migraine attacks, you need to figure out which triggers affect you and which ones don’t. Keeping a headache diary is an effective way to track triggers, and it will help you talk to your healthcare professional about your condition.
Bright sunshine, hot, humid conditions, and drastic changes in barometric pressure may lead to, or “trigger,” a migraine attack in some. However, studies have shown that weather does not act as a trigger for everyone who has migraine.
Hormones initiate and regulate many of your body’s functions, keeping your body in balance within a constantly changing environment. When the levels of hormones in your body are unbalanced – during menstruation, pregnancy, or menopause – it can lead to a migraine attack. In fact, about three quarters of all women with migraine report that their attacks are related to the menstrual cycle.
While the severity of a migraine attack often causes patients to fear they are having a stroke, the likelihood of a migraine attack causing a stroke is very remote. That is not to say that migraine sufferers cannot have a stroke associated with their migraines. In persons under age 40, the most common associated factor for stroke is migraine headache. However, over the course of a person’s normal life span, the occurrence of migraine headache may actually be associated with a reduced risk of dying from cerebrovascular disease due to stroke.
Acute medications – sometimes referred to as acute abortive medications – are used to treat the pain of the headache after it has started. Examples of acute abortive medications include over-the-counter medications, NSAIDs, ergots, and triptans.
Triptans are the newest class of abortive medications specifically targeted to treat migraine. In addition to being vasoconstrictors, they moderate some chemical reactions in the brain. The triptans work on receptors in your brain, helping to restore the balance of a neurotransmitter called serotonin. Changing levels of serotonin are thought to be a main cause of migraine.
Over-the-counter, or “OTC,” medications may be effective in relieving mild to moderate pain and associated symptoms of migraine. However, you should see your doctor before beginning any treatment regimen for migraine.
Preventive medications for migraine – sometimes referred to as “prophylactic” treatments – are used to reduce the frequency, severity, and length of migraine attacks. Most preventive migraine medications were initially developed to treat other diseases, such as seizures, depression, or hypertension. Examples of preventive medications include antiepileptic medications, antidepressants, beta-blockers, calcium channel blockers, and NSAIDs (nonsteroidal anti-inflammatory drugs).
The newest preventitive medications are CGRP antagonists. With CGRP medications, monoclonal antibodies have been created that when administered to an individual with migraine will block the receptor sites on blood vessels or attach to CGRP itself so that it cannot fit into the receptor sites and thus interferes with the series of events that leads to migraine. Previously, most preventive migraine medications were initially developed to treat other diseases, such as seizures, depression, or hypertension. Some patients have benefited from taking antiepileptic drugs (sometimes referred to as “anticonvulsants”) for the prevention of migraine, as both epilepsy and migraine may be caused by similar reactions in the brain.
Many preventive migraine medications were initially developed to treat other diseases, such as seizures, depression, or hypertension. Antidepressants are typically used to treat people with depression, although they may reduce migraine frequency by regulating chemical levels in the brain.
The term “alternative therapies” is often used to describe treatments considered outside the scope of conventional Western medicine. Examples of alternative therapy include acupuncture, acupressure, and yoga. Another common alternative treatment is herbal therapy, as some herbs are believed to relieve headache pain. Always discuss alternative therapies with your doctor before proceeding.
Tension-type headaches occur randomly and are often the result of temporary stress, anxiety, fatigue, or anger. Symptoms include soreness in your temples, a tightening band-like sensation around your head (a “vice-like” ache), a pulling feeling, pressure sensations, and contracting head and neck muscles. The headache begins in your forehead, temples, or the back of your head and neck. Treatment for tension-type headache may include over-the-counter or prescription medications, as well as self-help techniques such as relaxation training and biofeedback.
Cluster headache gets its name because the attacks come in groups. The pain arrives with little, if any, warning and is usually on one side of the head. A tearing or bloodshot eye and a runny nose on the side of the headache may also accompany the pain. Cluster headache, believed to be caused by chemical reactions in the brain, has been described as the most severe and intense of any headache type. Treatment for cluster headache includes prescription medication and oxygen.
When a sinus becomes inflamed, usually as the result of an allergic reaction, a tumor, or an infection, the inflammation will cause a localized pain. If your headache is truly caused by a sinus blockage, such as an infection, you will probably have a fever. An x-ray will confirm a sinus blockage. Your physician’s treatment might include antibiotics for the infection, as well as antihistamines or decongestants.
A pattern of taking acute headache medications too often (more than two days per week) or in excessive amounts (more than the label or a doctor advises) can lead to a condition known as “rebound headache.” With rebound headache, your medications not only stop relieving pain, they actually begin to cause headaches. Doctors treat rebound headache by tapering the medication that is being overused, sometimes by gradually substituting a different type of treatment or medication. Stopping may be a challenge, but regularly overusing a medication increases the potential for serious side effects. Consult a physician if you regularly use headache medications more than two days per week or more than the label advises.
Biofeedback is a self-help treatment that utilizes special equipment to monitor your body’s involuntary physical responses such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. Biofeedback helps you refine and perfect your relaxation exercises by learning to control the physical responses that are related to stress. An important benefit to learning biofeedback is that, once the technique has been mastered, you don’t need the equipment any more.
According to estimates, approximately 29.5 million people in the United States suffer from migraine. Four out of five (80 percent) of them report a family history of migraine, but scientists are not sure if this is genetic or a family predisposition. Despite the uncertainty, a child has a 50% chance of having migraine if one parent suffers and a 75% chance if both parents suffer.
By the time they reach high school, most young people have experienced some type of headache. However, once your child’s physician discovers the cause and type of the headache, many safe and effective approaches or medications can prevent a headache from occurring or stop it after it has attacked.
A change in your sleep pattern — too much or too little — may instigate a headache. It is best to get the same amount of sleep each night and get up the same time each day, even on the weekend.
According to the National Headache Foundation, headaches are divided into two basic categories: primary/benign (tension-type, migraine, cluster) and secondary (organically caused). All headaches fall into one of these two categories depending on their causes and symptoms.
It’s not uncommon for an individual to experience more than one type of headache. According to the late Dr. Seymour Diamond, Founder of the National Headache Foundation, people with mixed headache problems — such as migraine with tension-type headache — are not unusual.
When seeking treatment for your headache, start with your primary care physician. Discuss his or her experience and approach to headaches, including methods of classification, diagnosis, and treatment. Your doctor may decide to recommend you to a headache specialist, depending upon your symptoms or other physical conditions (diabetes, allergies, etc.) that require a more comprehensive and inclusive approach to your headache. To find headache specialist in your state, use our Physician Finder.
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